John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

However, I had a really interesting discussion with an EHR vendor today (Side Note: they questioned if interoperability was that valuable) and I asked him the question of whether full healthcare interoperability is even possible.

I’d love to hear your thoughts. As we discussed it more, it was clear that we could have full interoperability if the data was just exported to files (PDFs, images, etc), but that’s really just a glorified fax machine like we do today. Although it could potentially be a lot faster and better than fax. The problem is that the data is then stuck in these files and can’t be extracted into the receiving EHR vendor.

On the other end of the spectrum is full interoperability of every piece of EHR data being transferred to the receiving EHR. Is this even possible or is the data so complex that it’s never going to happen?

The closest we’ve come to this is probably prescriptions with something like SureScripts. You can pull down a patient’s prescription history and you can upload to it as well. A deeper dive into its challenges might be a great study to help us understand if full healthcare data interoeprability is possible. I’m sure many readers can share some insights.

I’m interested to hear people’s thoughts. Should we trim down our interoperability expectations to something more reasonable and achievable? We’ve started down that path with prescriptions and labs. Should we start with other areas like allergies, family history, diagnosis, etc as opposed to trying to do everything? My fear is that if our goal is full healthcare data interoperability, then we’re going to end up with no interoperability.

The burden and cost of Interoperability should not be completely shouldered by EHR developers. HIMMS EHRA has repeatedly requested that the ONC introduce regulation and certification in Labs’ businesses as well, which are incredibly profitable, requiring them to standardize their coding and results data. EHRA members have also requested that the ONC require the state to standardize immunization registries. A small group of top vendors who are members of Commonwell are working to address the fundamental issue of patient identification.

If the US is going to have universal interoperability, EHR vendors need reasonable help.Is it reasonable that they be required to develop for HIEs in 50 states? or hundreds of labs? or 50 state immunization registries? 20+ years ago practice management software vendors were required to develop, a maintain and support hundreds of direct direct eclaims templates for all the individual Medicare carriers in the US at extraordinary expense. CMS stepped in and placed requirements on the carriers, making it possible for clearinghouses to accept claims for virtually all commercial and government plans from the the vendors’ software. When is that going to happen for Labs and immunizations?

Interoperability is not a pipe dream. The infrastructure to interoperate is now in place at all MU2 EHRs certified for the Direct Messaging components. The first payloads are to be those for Transitions of Care, but Direct is well-positioned to serve additional use cases.

EHR vendors and HISPs are working together to make sure interoperability is a reality. For example, DirectTrust is coordinating end to end testing of CCDA transmit and incorporate this summer. Any certified EHR endpoint using a DirectTrust HISP that’s in their current trust bundle can participate in this testing.

Julie Mass is correct. Any EHR vendor that certified for Stage 2 can communicate discrete data with other EHRs. It is a beautiful thing. The one caveat is the process for linking the patient. There is no universal medical record number that each patient can provide to the medical facilities, so when a direct message arrives for a patient at the receiving EHR the operator must perform the link process manually. That is completed by looking at the demographics data viewed on the C-CDA and searching for the match on the receiving EHR. Hopefully the the receiving EHR built a user friendly interface that makes this process safe and easy. It is taking some time to get the kinks worked out of the DirectTrust HISP transportation environment but that should be expected. This is the part of Meaningful Use that will make it all worth while. This is the piece that will have the most significant positive impact on the quality of patient care.

Data harmonization, that is, linking patient record to patient record without a universally accepted and implemented unique patient ID is impractical, terribly error prone and expensive.

Can you imagine trying to control air traffic without access to a plane’s flight number and instead asking the airline, pilot name for each communication? Or think about the duplicate, incorrect mailings you received from companies that think they have your proper name and address.

Want that level of accuracy to govern your EHR? That’s about what trying to ID patients is like using manual matching techniques.

I hope I did not give the impression in my prior post that the manual patient reconciliations would be done in a haphazard bulk batch mode.

When a patient’s C-CDA arrives at a medical facility from another medical facility it will almost always be associated with an appointment that patient made at the receiving medical facility. The receiving facility will welcome the information just as they would receiving a fax from the transmitting EHR.

Currently medical facilities fax important patient medical information between themselves. When a fax comes in it still has to be collated to the appropriate paper chart or scanned into the appropriate EHR chart manually.

If the EHRs are well designed this process should be safer than all the manual repetitive data entry that takes place now as a patient goes from one medical facility to another.

I think Interoperability is not a dream. The infrastructure to interoperate is now in place at all Meaningful Use Stage2 EHRs certified for Direct Messaging component. Its all about time, after some time every one using EHR like today they are using i phones.